Cushing syndrome is caused by chronic exposure of the body’s tissues to high levels of cortisol—a hormone produced by the adrenal glands. This can be from long-term use of certain medications or tumors of the pituitary or adrenal glands. Your treatment will depend on why you have too much cortisol. Learn more about this rare disorder.
Adrenal Gland and Cortisol Molecules
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Overview
Hypercortisolism
Image by BruceBlaus/Wikimedia
Hypercortisolism
An illustration depicting hypercortisolism.
Image by BruceBlaus/Wikimedia
About Cushing Syndrome
Cushing syndrome occurs when the body’s tissues are exposed to too much of the hormone cortisol or a medication similar to cortisol for too long. The syndrome is named after Harvey Cushing, the brain surgeon who first described the condition.
Cortisol is an essential hormone for life. The body’s two adrenal glands produce the hormone cortisol daily for our routine activities and a higher amount of cortisol in response to stress or when the cortisol levels in the blood are lower than they should be.
In the right amount, cortisol helps the body with several vital tasks:
Maintaining blood pressure and heart function
Controlling the immune system
Turning food into energy
Raising blood sugar levels as needed
Controlling bone formation
If the body makes too much cortisol or gets too much from external sources, like medications, Cushing syndrome may occur. Whether you develop Cushing syndrome depends on factors such as how much medication you take and for how long or how large a tumor grows before it is detected and treated.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Additional Materials (12)
Cushing's Disease Treatment
Video by UC San Diego Health/YouTube
What is Cushing's Disease?
Video by Swedish/YouTube
Cushing Syndrome, Causes, Signs and Symptoms, Diagnosis and Treatment.
Video by Medical Centric/YouTube
Rare Disease Research at NICHD: Cushing Syndrome Clinical Trials
Video by NICHDVideos/YouTube
Cushing's Syndrome- Information and Help
Video by The Balancing Act/YouTube
Cushing Disease & ACTH-Secreting Pituitary Tumors – Mayo Clinic
Cushing’s syndrome is a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cortisol is sometimes called the “stress hormone” because it helps your body respond to stress. Cortisol also helps
maintain blood pressure
regulate blood glucose, also called blood sugar
reduce inflammation
turn the food you eat into energy
The adrenal glands, two small glands on top of your kidneys, make cortisol.
The adrenal glands, two small glands on top of your kidneys, make cortisol.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (3)
What is Cushing’s syndrome?
Video by UW Health/YouTube
Cushing Syndrome
Video by CanadaQBank/YouTube
Erin Kelley treated for Cushing's Syndrome
Video by Barnes-Jewish Hospital/YouTube
1:08
What is Cushing’s syndrome?
UW Health/YouTube
10:29
Cushing Syndrome
CanadaQBank/YouTube
1:35
Erin Kelley treated for Cushing's Syndrome
Barnes-Jewish Hospital/YouTube
Is It Common?
Health Statistics
Image by geralt/Pixabay
Health Statistics
Image by geralt/Pixabay
How Common Is Cushing’s Syndrome?
Endogenous Cushing’s syndrome is rare. “Endogenous” means something inside your body is causing the disorder rather than something outside your body, such as medicine. Estimates vary, ranging from about 40 to 70 people out of every million.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (3)
Behind the Mystery Rare & Genetic Series - Endogenous Cushing's Syndrome
Video by The Balancing Act/YouTube
Cushing Syndrome - an Osmosis Preview
Video by Osmosis/YouTube
Rare Disease Research at NICHD: Cushing Syndrome Clinical Trials
Video by NICHDVideos/YouTube
9:02
Behind the Mystery Rare & Genetic Series - Endogenous Cushing's Syndrome
The Balancing Act/YouTube
1:23
Cushing Syndrome - an Osmosis Preview
Osmosis/YouTube
3:44
Rare Disease Research at NICHD: Cushing Syndrome Clinical Trials
NICHDVideos/YouTube
What You Need To Know
Corticotropin
Image by TheVisualMD
Corticotropin
Adrenocorticotropic hormone is a polypeptide tropic hormone produced and secreted by the anterior pituitary gland. It is an important component of the hypothalamic-pituitary-adrenal axis and is often produced in response to biological stress (along with its precursor corticotropin-releasing hormone from the hypothalamus). Its principal effects are increased production and release of corticosteroids. A deficiency of ACTH is a cause of secondary adrenal insufficiency and an excess of it is a cause of Cushing's syndrome.
Image by TheVisualMD
Cushing's Syndrome Information
What is Cushing's syndrome?
Cushing's syndrome, also known as hypercortisolism, is a rare endocrine disorder caused by chronic exposure of the body's tissues to excess levels of cortisol—a hormone naturally produced by the adrenal gland. Neurological symptoms include muscle weakness and difficulties with memory and concentration.
Common symptoms of Cushing's syndrome include:
Upper body obesity
Severe fatigue
High blood pressure
Backache
Elevated blood sugar
Easy bruising
Bluish-red stretch marks on the skin
In women, there may be increased growth of facial and body hair, and menstrual periods may become irregular or stop completely. Treatments for the disorder are available but Cushing's syndrome can be fatal if not treated.
Cushing's syndrome most often affects adults but can occur in children. It affects about as three times as many women as men.
How can I or my loved one help improve care for people with Cushing's syndrome?
Cushing's syndrome is considered a rare disease, which means there is often not much information known about the disorder. This is usually the case because doctors and researchers do not see enough patients with Cushing's syndrome, which makes it hard to learn from them through observations or large studies.
Consider participating in a clinical trial so clinicians and scientists can learn more about Cushing's syndrome and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.
All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.
Source: National Institute of Neurological Disorders and Stroke (NINDS)
High Cortisol Levels, What Female Symptoms Indicate This?
EmpowHER/YouTube
12:26
Human Physiology - Cortisol Feedback and Function
Janux/YouTube
2:41
The Complexities of Cortisol
University of California Television (UCTV)/YouTube
Risk Factors
Population statistics
Image by ArtsyBeeKids/Pixabay
Population statistics
Image by ArtsyBeeKids/Pixabay
Who Is More Likely to Have Cushing’s Syndrome?
Cushing’s syndrome most often affects adults, usually aged 30 to 50, but can also occur in children. Cushing’s syndrome affects about three times as many women as men. In people who have type 2 diabetes and blood glucose levels that stay too high over time, along with high blood pressure, Cushing’s syndrome may be the cause. People who take medicines called glucocorticoids, which are similar to cortisol, also can develop Cushing’s syndrome. This type of Cushing’s syndrome is called “exogenous.” More than 10 million Americans take glucocorticoids each year, but it’s not known how many of them develop Cushing’s syndrome.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
The Voices of Cushing’s Disease, Part I: Living with the Reality
Video by Novartis/YouTube
4:20
The Voices of Cushing’s Disease, Part I: Living with the Reality
Novartis/YouTube
Causes
Overview of glucocorticoid-associated side effects
Image by Timmermans S, Souffriau J and
Libert C/Wikimedia
Overview of glucocorticoid-associated side effects
Schematic abstract showing glucocorticoid associated side effects
Image by Timmermans S, Souffriau J and
Libert C/Wikimedia
What Causes Cushing Syndrome?
Cushing syndrome can develop for two reasons:
Medication that contains glucocorticoid, which is similar to cortisol
A tumor in the body that makes the adrenal gland produce too much cortisol
Medication
Medications cause most cases of Cushing syndrome. Glucocorticoids, steroid drugs that are similar to cortisol, are a primary medication linked to Cushing syndrome. Healthcare providers prescribe them to treat:
Allergies
Asthma
Autoimmune diseases, in which the body’s immune system attacks its own tissues
Organ rejection, such as following an organ transplant
Cancer
Glucocorticoids such as prednisone are good for reducing inflammation. However, taking a high dose for a long time can cause Cushing syndrome.
Medroxyprogesterone, a form of the hormone progesterone, can also cause Cushing syndrome. Women may take it to treat menstrual problems, irregular vaginal bleeding, or unusual growth of the uterine (womb) lining, called endometriosis.
Tumors
A tumor in the body can also cause Cushing syndrome. However, tumors are a much less common cause of Cushing syndrome than are medicines.
Both cancerous and noncancerous tumors can cause Cushing syndrome. The following list includes some of the different types of tumors.
Noncancerous (or benign)
Pituitary adenoma. An adenoma is a kind of tumor. A pituitary adenoma is on the pituitary gland.
Adrenal adenoma. An adrenal adenoma is on an adrenal gland.
Adrenal hyperplasia (micronodular or macronodular), or an overproduction or overgrowth of certain types of cells in the adrenal gland (tumor)
Adenomas in other places, such as the lungs, pancreas, thyroid, or thymus
Cancerous (or malignant)
Adrenal cancer
Pituitary carcinoma. A carcinoma is a kind of cancer. Pituitary carcinoma is very rare.
Cancer in places other than the pituitary or adrenal glands, mostly in the lungs, pancreas, thyroid, or thymus
How tumors can cause Cushing syndrome
Normally, the pituitary gland in the brain controls how much cortisol the body’s two adrenal glands release into the bloodstream. The pituitary gland signals the adrenal glands by releasing adrenocorticotropic hormone, also known as ACTH. When the adrenal glands sense the ACTH, they produce more cortisol. A tumor can disrupt that action. Tumors can produce either extra cortisol directly in their own tissue or extra ACTH, which triggers production of more cortisol.
Here are three ways a tumor can cause Cushing syndrome:
A benign tumor in the pituitary gland secretes ACTH, which causes the adrenal glands to produce too much cortisol. This tumor, called a pituitary adenoma, is the most common tumor linked to Cushing syndrome. Cushing syndrome that results from a pituitary adenoma is called Cushing disease.
Tumors in one or both adrenal glands produce cortisol, adding to the normal amount already produced by the glands themselves. These tumors can be adrenal adenomas, adrenal hyperplasia, or adrenal cancer.
A tumor in the lungs produces ACTH. The adrenal glands detect the ACTH and make more cortisol. This condition is sometimes called ectopic Cushing syndrome. The tumors may be benign or malignant.
Familial Cushing syndrome
Certain rare genetic disorders make some people more likely to get tumors in glands that influence cortisol levels. People who have one of these disorders are more likely to develop Cushing syndrome. Two such conditions are called multiple endocrine neoplasia type 1 and primary pigmented micronodular adrenal disease.
Physiologic/non-neoplastic hypercortisolism
In a few cases, people have symptoms and test results that suggest Cushing syndrome, but further testing reveals they do not have the syndrome. This condition is called physiologic/non-neoplastic hypercortisolism. It is very rare. The symptoms can be caused by alcohol dependence, depression or other mental health disorders, extreme obesity, pregnancy, or poorly controlled diabetes.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Additional Materials (4)
Cushing Disease & ACTH-Secreting Pituitary Tumors – Mayo Clinic
Video by Mayo Clinic/YouTube
Cushing's Syndrome and Corticosteroids (Part 2)
Video by Medicurio/YouTube
Cushing Syndrome, Animation
Video by Alila Medical Media/YouTube
Negative Feedback Loop
The release of adrenal glucocorticoids is stimulated by the release of hormones from the hypothalamus and pituitary gland. This signaling is inhibited when glucocorticoid levels become elevated by causing negative signals to the pituitary gland and hypothalamus.
Image by CNX Openstax
3:41
Cushing Disease & ACTH-Secreting Pituitary Tumors – Mayo Clinic
Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain.
The most common cause of Cushing’s syndrome is the long-term, high-dose use of the cortisol-like glucocorticoids. These medicines are used to treat other medical conditions, such as asthma, rheumatoid arthritis, and lupus. Glucocorticoids are often injected into a joint to treat pain. Use of glucocorticoids also suppresses the immune system after an organ transplant to keep the body from rejecting the new organ.
Other people develop endogenous Cushing’s syndrome because their bodies make too much cortisol. Several types of tumors can cause the body to make excess cortisol.
Pituitary tumors
Pituitary tumors, also called pituitary adenomas, are noncancerous growths on the pituitary gland. The pituitary gland sits at the base of the brain and is about the size of a pea. The pituitary makes adrenocorticotropic hormone (ACTH) and other hormones. ACTH tells the adrenal glands to make cortisol. These pituitary tumors make too much ACTH, causing the adrenals to make too much cortisol.
The pituitary gland sits at the base of the brain.
Pituitary tumors that make too much ACTH cause 8 out of 10 cases of Cushing’s syndrome not caused by glucocorticoid medicines. Doctors call this type of Cushing’s syndrome Cushing’s disease.
Ectopic ACTH-producing tumors
Some tumors that develop outside the pituitary gland also can produce ACTH. This condition is called ectopic ACTH syndrome. Most often, these tumors occur in the lungs. Ectopic tumors also can occur in the pancreas, thyroid, and thymus—a gland that helps build a healthy immune system. Ectopic tumors may be cancerous.
Adrenal tumors
Sometimes a tumor on the adrenal gland itself makes too much cortisol. Adrenal tumors are most often benign but sometimes are cancerous.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (4)
Pituitary Tumor
The pituitary gland is located in the sella turcica of the sphenoid bone within the cranial floor, placing it immediately inferior to the optic chiasm. If the pituitary gland develops a tumor, it can press against the fibers crossing in the chiasm. Those fibers are conveying peripheral visual information to the opposite side of the brain, so the patient will experience “tunnel vision”—meaning that only the central visual field will be perceived.
Image by CNX Openstax
Pituitary Tumor - Defined
Pituitary tumor
Image by BruceBlaus
Female Hormone Loop
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone (LH) and luteinizing hormone-releasing hormone (LHRH). The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone (FSH). LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium (inner lining of the uterus). (When estrogen and progesterone production reaches a certain level during the menstrual cycle, these hormones act on the hypothalamus and pituitary to turn off production of LHRH, LH, and FSH.)
Transsphenoidal surgery. An endoscope and a curette are inserted through the nose and sphenoid sinus to remove cancer from the pituitary gland.
Transsphenoidal surgery: A type of surgery in which the instruments are inserted into part of the brain by going through an incision (cut) made under the upper lip or at the bottom of the nose between the nostrils and then through the sphenoid bone (a butterfly-shaped bone at the base of the skull) to reach the pituitary gland. The pituitary gland lies just above the sphenoid bone.
Primary pigmented micronodular adrenal disease, in which children or young adults develop small cortisol-producing tumors of the adrenal glands,
Multiple endocrine neoplasia type 1 (MEN1), in which hormone-secreting tumors of the parathyroid glands, pancreas, and pituitary develop. Cushing's syndrome in MEN1 may be due to pituitary or adrenal tumors.
Source: Genetic and Rare Diseases (GARD) Information Center
Additional Materials (1)
What is MEN1?
Video by UW Health/YouTube
0:50
What is MEN1?
UW Health/YouTube
Symptoms
Cushing's syndrome
Image by Mikael Haggstrom
Cushing's syndrome
Symptoms of Cushing's syndrome.
Image by Mikael Haggstrom
What Are the Symptoms of Cushing Syndrome?
Cushing syndrome can cause a range of symptoms. The symptoms might also be similar to those of other conditions.
Physically, someone with Cushing syndrome might:
Be heavy or obese above the waist but have thin arms and legs
Have a round, red face, sometimes referred to as a moon face
Have a fat lump between the shoulders, sometimes called a buffalo hump
Have weak muscles or bones including osteoporosis, bone pain, and fractures
Have skin changes, including:
New or worsened acne or skin infections
Reddish-purple stretch marks called striae (pronounced STRY-ee). These are usually about half an inch wide and can appear on the abdomen, buttocks, thighs, arms, and breasts.
Thin, fragile skin that bruises easily and heals poorly
Additional symptoms can include the following:
Children may get heavier but grow more slowly than their peers.
Women may have more hair on their face, neck, chest, abdomen, and thighs. They may experience menstrual problems, such as irregular or stopped periods.
Men may have lower sex drive, experience impotence, and become less fertile.
The following less common symptoms also may develop:
Mental changes such as depression, anxiety, moodiness, or behaving differently
Severe fatigue
Headaches
Thirst and increased need to urinate
High blood pressure
High blood sugar
High cholesterol and triglycerides
Overall, the symptoms that most strongly hint at Cushing syndrome are the fatty deposit on the upper back/neck, fat around the abdomen, weakness in muscles closest to the torso (such as in the shoulders and hips), wide striae (skin stripes), bruising without being bumped, unexplained osteoporosis, and—in children—slower growth in height and more weight gain that may be mistaken for obesity.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Additional Materials (7)
Sensitive content
This media may include sensitive content
Physical examination revealed features of Cushing syndrome including round facies, acne, plethora, central obesity, and poor muscle tone.
Image by Elizabeth B. Fudge,1 Daniel von Allmen,2 Keith E. Volmar,3 and Ali S. Calikoglu1
Stretchmarks by an Cushing patient
Image by PanaromicTiger/Wikimedia
Sensitive content
This media may include sensitive content
Straie with cushing syndrome
What is Cushing syndrome?
Cushing syndrome is a hormonal disorder caused by prolonged exposure to inappropriately high levels of plasma glucocorticoid (also referred to as cortisol) hormones. Glucocorticoid hormones maintain glucose regulation, suppress the immune response and are released as part of the body's response to stress. The production of cortisol from within the cortex of the adrenal glands is regulated by a small gland just below the brain called the pituitary gland.
There are several causes of Cushing syndrome:
Adrenocortical hyperplasia (overgrowth of adrenal cortex) secondary to pituitary overproduction of adrenocorticotrophic hormone (ACTH) Benign or malignant adrenal tumours that release excess glucocorticoids into the blood Ectopic ACTH sydrome – secretion of ACTH by malignant or benign tumours arising in structures other than the pituitary or adrenal glands
Exogenous steroid administration – usually from administration of high doses of systemic corticosteroids such as prednisone for blistering diseases, asthma, arthritis and other inflammatory diseases.
Image by Masryyy/Wikimedia
Cushing Syndrome, Causes, Signs and Symptoms, Diagnosis and Treatment.
Video by Medical Centric/YouTube
Addisons vs Cushing's Disease for NCLEX RN
Video by Simple Nursing/YouTube
What is Cushing's Syndrome and what are its signs and symptoms?
Person's facial appearance 3 months after treatment with inhaled fluticasone.
Image by Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu
Pat. mit Cushing-Syndrom
Pat. mit Cushing-Syndrom
Image by Klausur 123/Wikimedia
Sensitive content
This media may include sensitive content
Physical examination revealed features of Cushing syndrome including round facies, acne, plethora, central obesity, and poor muscle tone.
Elizabeth B. Fudge,1 Daniel von Allmen,2 Keith E. Volmar,3 and Ali S. Calikoglu1
Stretchmarks by an Cushing patient
PanaromicTiger/Wikimedia
Sensitive content
This media may include sensitive content
Straie with cushing syndrome
Masryyy/Wikimedia
6:39
Cushing Syndrome, Causes, Signs and Symptoms, Diagnosis and Treatment.
Medical Centric/YouTube
15:41
Addisons vs Cushing's Disease for NCLEX RN
Simple Nursing/YouTube
What is Cushing's Syndrome and what are its signs and symptoms?
Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu
Pat. mit Cushing-Syndrom
Klausur 123/Wikimedia
Diagnosis
Low-dose dexamethasone suppression test (LDDST)
Image by NIDDK
Low-dose dexamethasone suppression test (LDDST)
In the LDDST test, you will have blood drawn after taking a low dose of dexamethasone.
In this test, you will take a low dose of dexamethasone, a type of glucocorticoid, usually around 11:00 p.m. A health care professional will draw your blood the following morning, usually around 8 a.m. Sometimes doctors use another type of LDDST test, in which you take dexamethasone every 6 hours for 48 hours. Your blood is drawn 6 hours after the last dose.
Normally, cortisol levels in the blood drop after taking dexamethasone. Cortisol levels that don’t drop suggest Cushing’s syndrome.
When one of the first blood tests show that your body has too much cortisol, your doctor may order a follow-up test, called the dexamethasone–corticotropin-releasing hormone (dexamethasone-CRH) test.
Image by NIDDK
How Do Healthcare Providers Diagnose Cushing Syndrome?
Diagnosing Cushing syndrome can be complex and difficult. This syndrome is easier to recognize once it develops fully, but healthcare providers try to diagnose and treat it before it gets to that point. No single test can definitively diagnose the condition, so healthcare providers often use several steps to diagnose Cushing syndrome. If you are being checked for Cushing syndrome, the tests may occur in the following order:
First Step
Your healthcare provider will ask about all medications and other treatments you have taken to see whether any of them could be responsible for raising your cortisol levels. Make sure you include everything you take, including joint or nerve injections received for pain; “tonics,” dietary supplements, and herbal medications; nasal sprays; progesterone; and skin creams (including bleaching agents).
Second Step
A laboratory will check to see whether your cortisol levels are normal. This test might be one of the following:
Urine cortisol test
Urine is collected for 24 hours.
Late-night salivary cortisol test
A special device is used for collecting saliva late at night. You can mail the sample to a laboratory or deliver it to your healthcare provider.
Dexamethasone suppression test
For this test, you take dexamethasone, a drug that suppresses or stops cortisol production, by mouth, and then your blood level of cortisol is measured. The test may be done overnight or across 3 days.
Third Step
If your results are not normal, your healthcare provider may do further tests or refer you to an endocrinologist, a healthcare provider who specializes in hormones and hormone disorders, for the tests. These tests might include:
Another test from Step 2
Serum midnight cortisol test, which measures the amount of cortisol in your blood late at night
Dexamethasone-suppressed corticotropin-releasing hormone (Dex-CRH) test, which can help determine the cause of the symptoms
Fourth Step
If your cortisol levels are still above normal and you receive a diagnosis of Cushing syndrome, your healthcare provider will check for the cause. Tests to find the cause might include the following:
A CRH stimulation test, which involves a series of blood samples
A high-dose dexamethasone suppression test, a variation on the dexamethasone suppression test described earlier
Magnetic resonance imaging (MRI) or other imaging to see the glands that might be causing symptoms
Petrosal sinus sampling, which is a blood test that measures levels of ACTH coming from the pituitary gland
Exceptions to Testing Steps
Certain medical conditions can make some of the tests listed earlier unsafe or ineffective, so your healthcare provider may not use the tests. These conditions can include:
Pregnancy
Epilepsy
Renal failure
Cyclic Cushing syndrome, in which cortisol is sometimes normal and sometimes high
In addition, several kinds of medications unrelated to Cushing syndrome may interfere with test results. Make sure your healthcare provider knows about every drug you are taking before testing for Cushing syndrome.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Additional Materials (4)
dexamethasone test
Chemical structure of dexamethasone
Image by The original uploader was Kevyn at English Wikipedia.
Cushing Syndrome Diagnostic Workup
Video by Medicosis Perfectionalis/YouTube
Cushing's disease - diagnosis and treatment with Malini Raj (Australian Pituitary Foundation)
Video by Australian Pituitary Foundation Videos/YouTube
Indium white blood cell scan
111In-pentetreotide scintigraphy of the 41-year-old man with ectopic Cushing' syndrome caused by a neuroendocrine carcinoma of the mesentery. Radiotracer accumulation in the left thyroid in 10/2003 (arrow). The mesenterial neuroendocrine tumor became clearly visible in 4/2005 (arrow).
Image by Mathias Fasshauer et al.
dexamethasone test
The original uploader was Kevyn at English Wikipedia.
8:59
Cushing Syndrome Diagnostic Workup
Medicosis Perfectionalis/YouTube
2:31
Cushing's disease - diagnosis and treatment with Malini Raj (Australian Pituitary Foundation)
Australian Pituitary Foundation Videos/YouTube
Indium white blood cell scan
Mathias Fasshauer et al.
Finding the Cause
Adrenocorticotropic Hormone
Image by TheVisualMD
Adrenocorticotropic Hormone
In normal functioning, environmental stress activates the hypothalamus to release corticotrophin releasing factor (CRF) which in turn stimulates the pituitary gland to increase production of adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal gland to release cortisol. It is cortisol that produces effects to help us deal with stress.
Image by TheVisualMD
How Do Doctors Find the Cause of Cushing’s Syndrome?
Once your doctor diagnoses Cushing’s syndrome, other tests can help tell whether the source of the problem is pituitary, ectopic, or adrenal. Knowing the source is important in choosing the best type of treatment.
Blood tests
The first step is to measure ACTH levels in the blood. If ACTH levels are low, the cause is probably an adrenal tumor. People with adrenal tumors don’t need further blood tests.
If ACTH levels are normal or high, the cause is probably a pituitary or ectopic tumor.
Other blood tests help tell pituitary tumors from ectopic tumors. Doctors usually do more than one test.
CRH stimulation test. For this test, you’ll get a shot of CRH. If you have a pituitary tumor, CRH will increase the ACTH and cortisol in your blood. This rarely happens in people with ectopic tumors.
High-dose dexamethasone suppression test (HDDST). This test is the same as the LDDST, except it uses higher doses of dexamethasone. If the cortisol levels in your blood drop after taking a high dose of dexamethasone, you probably have a pituitary tumor. If your cortisol levels don’t drop, you may have an ectopic tumor.
Other tests
Other tests look for tumors and help tell pituitary tumors from ectopic tumors.
Imaging tests. Imaging tests show the size and shape of the pituitary and adrenal glands and look for tumors. If blood tests show that the tumor is ectopic, imaging tests can help locate the tumor. The most common imaging tests are the computerized tomography (CT) scan and magnetic resonance imaging (MRI).
The most common imaging tests are CT scans and MRI.
Petrosal sinus sampling. Pituitary tumors are usually small and may not show up in an imaging test. If an MRI doesn’t show a pituitary tumor, you might have petrosal sinus sampling. This test is often the best way to tell pituitary from ectopic causes of Cushing's syndrome.
Your doctor will draw samples of blood from your petrosal sinuses—veins that drain the pituitary. At the same time, you will have a blood sample taken from a blood vessel far away from the pituitary. You will also get a shot of CRH, the hormone that causes the pituitary to release ACTH.
Higher levels of ACTH in the blood from the petrosal sinuses than from the other blood vessel indicate a pituitary tumor. Similar levels of ACTH in all the blood samples suggest an ectopic tumor.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (2)
CRH Stimulation Test - Indication, Mechanism, and Results (Corticotropin-Releasing Hormone)
Video by USMLE pass/YouTube
Understanding The Dexamethasone Suppression Test
Video by Zero To Finals/YouTube
2:11
CRH Stimulation Test - Indication, Mechanism, and Results (Corticotropin-Releasing Hormone)
USMLE pass/YouTube
7:55
Understanding The Dexamethasone Suppression Test
Zero To Finals/YouTube
What Tests Are Done?
Blood Test
Image by Belama/Pixabay
Blood Test
Blood Test
Image by Belama/Pixabay
How Do Doctors Diagnose Cushing’s Syndrome?
Cushing’s syndrome can be hard to diagnose. Symptoms such as fatigue and weight gain can have many different causes. Cushing’s syndrome may be mistaken for other conditions that have many of the same signs, such as polycystic ovary syndrome or metabolic syndrome. Your doctor will first want to rule out other conditions.
Diagnosis is based on your medical history, a physical exam, and lab tests. Your doctor may ask if you are taking glucocorticoids or have had injections and rule that out before ordering lab tests.
Doctors may use urine, saliva, or blood tests to diagnose Cushing’s syndrome. Sometimes doctors run a follow-up test to find out if excess cortisol is caused by Cushing’s syndrome or has a different cause.
No one test is perfect, so doctors usually do two of the following tests to confirm a diagnosis:
24-hour urinary free-cortisol test
In this test, you will collect your urine over a 24-hour period. Your health care professional will send your urine sample to a lab to test cortisol levels. Higher than normal cortisol levels suggest Cushing’s syndrome.
Late-night salivary cortisol test
This test measures the amount of cortisol in your saliva in the late evening. Normally, cortisol production drops just after we fall asleep. In Cushing’s syndrome, cortisol levels don’t drop. You can collect your saliva sample at home and return it to your health care professional or send it to a lab for testing.
Low-dose dexamethasone suppression test (LDDST)
In this test, you will take a low dose of dexamethasone, a type of glucocorticoid, usually around 11:00 p.m. A health care professional will draw your blood the following morning, usually around 8 a.m. Sometimes doctors use another type of LDDST test, in which you take dexamethasone every 6 hours for 48 hours. Your blood is drawn 6 hours after the last dose.
Normally, cortisol levels in the blood drop after taking dexamethasone. Cortisol levels that don’t drop suggest Cushing’s syndrome.
In the LDDST test, you will have blood drawn after taking a low dose of dexamethasone.
When one of the first blood tests show that your body has too much cortisol, your doctor may order a follow-up test, called the dexamethasone–corticotropin-releasing hormone (dexamethasone-CRH) test.
Dexamethasone–CRH test
The dexamethasone-CRH test shows whether excess cortisol is caused by Cushing’s syndrome or by something else.
Some people have high cortisol levels off and on but don’t develop the long-term health effects of Cushing's syndrome. These people may have pseudo-Cushing's syndrome, a condition sometimes found in people who have depression or anxiety, drink too much alcohol, have diabetes with blood glucose levels that are often too high, or have obesity.
This test combines the LDDST and a CRH stimulation test. CRH is a hormone made in the part of the brain called the hypothalamus. CRH tells the pituitary to make ACTH, which in turn tells the adrenals to make cortisol. When cortisol levels rise enough, they turn off the CRH signal, so ACTH and cortisol levels fall.
CRH tells the pituitary to make ACTH, which in turn tells the adrenals to make cortisol.
You’ll get a shot of CRH and take dexamethasone by mouth. If you have pseudo-Cushing’s syndrome, the dexamethasone will decrease ACTH and cortisol levels and keep them from rising. Cortisol levels that are high just before the CRH shot or rise during this test suggest Cushing's syndrome.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (2)
Cushing's Syndrome
Video by NBC4 Columbus/YouTube
Anatomy and Physiology: Endocrine System: ACTH (Adrenocorticotropin Hormone) V2.0
Video by DrBruce Forciea/YouTube
2:05
Cushing's Syndrome
NBC4 Columbus/YouTube
2:22
Anatomy and Physiology: Endocrine System: ACTH (Adrenocorticotropin Hormone) V2.0
DrBruce Forciea/YouTube
Cortisol Test
Cortisol Test
Also called: Cortisol Levels
A cortisol test measures the level of cortisol in your blood, urine, or saliva. Cortisol is a hormone that helps your body respond to stress, regulate blood sugar, and fight infections. Maintaining an adequate balance of cortisol is essential for health.
Cortisol Test
Also called: Cortisol Levels
A cortisol test measures the level of cortisol in your blood, urine, or saliva. Cortisol is a hormone that helps your body respond to stress, regulate blood sugar, and fight infections. Maintaining an adequate balance of cortisol is essential for health.
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Use the slider below to see how your results affect your
health.
μg/dL
5
25
Your result is Normal.
Normally, the body produces the right amount of cortisol to keep it healthy. Cortisol is a hormone that helps the body respond to stress, regulate blood sugar, and fight infections.
Related conditions
{"label":"Cortisol (urine) reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Low","long":"Low","orientation":"horizontal"},"values":{"min":0,"max":10},"text":"If your urine cortisol levels are low, you may have Addison disease.","conditions":[]},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":10,"max":55},"text":"Normal values for cortisol in a urine test are 10 to 55 micrograms per day (24 hours).","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":55,"max":120},"text":"If your urine test reveals abnormally high levels of cortisol, you may be diagnosed with Cushing syndrome.","conditions":[]}],"units":[{"printSymbol":"\u03bcg\/h","code":"ug\/(24.h)","name":"microgram per 24 hour"}],"value":32.5}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
μg/h
10
55
Your result is Normal.
Normal values for cortisol in a urine test are 10 to 55 micrograms per day (24 hours).
Related conditions
A cortisol test measures the level of cortisol in your blood, urine, or saliva to see if your levels are normal. Cortisol is a hormone that affects almost every organ and tissue in your body. It helps your body:
Respond to stress (cortisol is sometimes called the "stress hormone")
Reduce inflammation
Regulate blood sugar and metabolism (how your body uses food for energy)
Control blood pressure
Cortisol is made by your adrenal glands, two small glands that sit above the kidneys. A gland in your brain, called the pituitary gland, makes a hormone that tells your adrenal glands how much cortisol to make. If your cortisol levels are too high or too low, it may mean you have a disorder of your adrenal glands, a problem with your pituitary gland, or a tumor that makes cortisol.
High levels of cortisol may also happen if you take large doses of certain steroid medicines, such as prednisone, for a long time. And low levels may happen if you stop the medicine suddenly.
Without treatment, cortisol levels that are too high or too low can be very serious.
A cortisol test is used to help diagnose medical conditions that cause too much or too little cortisol. These conditions include disorders that affect the adrenal glands:
Cushing's syndrome is a disorder that happens when your body has too much cortisol over a long period of time.
Addison disease is a condition in which your adrenal glands are damaged and can't make enough cortisol.
Secondary adrenal insufficiency is a condition in which your adrenal glands don't make enough cortisol because your pituitary gland isn't working properly.
Cortisol testing is also used to monitor treatment for these conditions.
You may need a cortisol test if you have symptoms of a condition that affects cortisol levels.
Symptoms of Cushing's syndrome (too much cortisol) may include:
Weight gain
Thin arms and legs
Round face
Increased fat around the base of the neck or between the shoulder blades
Easy bruising
Wide purple streaks on the stomach, breasts, hips, and under the arms
Muscle weakness
Common symptoms of Addison disease and adrenal insufficiency (not enough cortisol) may include:
Long-lasting fatigue
Muscle weakness
Loss of appetite
Weight loss
Abdominal (belly) pain
A cortisol test often uses a sample of blood drawn at a lab. But the test may also be done on urine or saliva collected at home. Normally, cortisol levels vary during the day, so your provider may order more than one type of test to get more information about your cortisol levels.
For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Blood samples are usually taken twice during the day--once in the morning when cortisol levels are at their highest, and again around 4 p.m., when levels are much lower.
For a cortisol urine test, your provider may ask you to collect all your urine during a 24-hour period. This is called a "24-hour urine sample test." For this test, you'll be given a special container and instructions for how to collect and store your urine sample. Your provider will tell you what time to start. The test usually includes the following steps:
To begin, urinate in the toilet as usual. Do not collect this urine. Write down the time you urinated.
For the next 24 hours, collect all your urine in the container.
Store the urine container in a refrigerator or in a cooler with ice during the collection period.
24 hours after starting the test, try to urinate if you can. This is the last urine collection for the test.
Return the container with your urine to your provider's office or the laboratory as instructed.
In certain cases, a urine test for cortisol may be done on one sample of urine collected in the morning.
A cortisol saliva test is usually done at home with a kit to collect a saliva sample. Your provider will tell you what time to collect your sample. It's often done at night before you go to bed when cortisol levels are normally lower.
Most kits include a swab and a container to store it. Be careful to follow the instructions that come with your kit. They usually include these general steps:
Do not eat, drink, brush, or floss your teeth for 30 minutes before the test.
Wash and dry your hands.
Open the tube that holds the swab and let the swab fall into your mouth without touching it with your hands.
Roll the swab in your mouth or hold it under your tongue for about 2 minutes until it is soaked with saliva.
Spit the swab back into the tube without touching it and close the tube.
Label the tube with the time you collected the sample.
Take your saliva sample to your doctor's office or the lab the next day as instructed.
The preparations will depend on the type of test you are having. Be sure to follow all the instructions that your provider gives you.
Stress can raise your cortisol levels, so you may need to rest before your test. A blood test will require you to schedule two appointments at different times of the day. Before a saliva test, you may need to stop using certain medicines. Let your provider know about all medicines you use, including skin creams. But don't stop using any medicines without talking with your provider first.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
There are no known risks to a urine or saliva test.
A cortisol test alone can't diagnose the cause of abnormal cortisol levels. If your cortisol level isn't normal, you will usually have more tests to find out what is causing the problem.
High levels of cortisol may be a sign that you have Cushing's syndrome. It may be caused by:
Taking high doses of certain steroid medicines for a long time to treat conditions, such as asthma, rheumatoid arthritis, and lupus
Tumors in your pituitary gland or other parts of your body that make too much of the hormone that tells your adrenal glands to make cortisol
Tumors in your adrenal glands that make extra cortisol
Low levels of cortisol may mean you have Addison disease or secondary adrenal insufficiency:
Common causes of Addison's disease include damage to the adrenal glands from conditions, such as:
Autoimmune diseases
Certain infections, such as tuberculosis (TB) and HIV/AIDS
Common causes of secondary adrenal insufficiency include:
Autoimmune diseases
Problems with the pituitary gland
Traumatic brain injury
The most common cause of low cortisol levels is suddenly stopping steroid medicines after using them for a long time.
If your cortisol results aren't normal, it doesn't always mean you have a medical condition that needs treatment. Cortisol levels can be affected by:
Stress
Pregnancy
Exercise
Serious illness
Hot and cold temperatures
Certain thyroid diseases
Obesity
Certain medicines, such as birth control pills
To learn what your test results mean, talk with your health care provider.
A cortisol test is one of the tests that may be used to help diagnose congenital adrenal hyperplasia (CAH). CAH is a group of inherited disorders in which the adrenal glands don't make enough cortisol.
Cortisol Test: MedlinePlus Medical Test [accessed on Mar 08, 2024]
Cortisol (Urine) - Health Encyclopedia - University of Rochester Medical Center [accessed on Mar 08, 2024]
Cortisol in Blood Test | HealthLink BC [accessed on Mar 08, 2024]
Cortisol in Urine Test | HealthLink BC [accessed on Mar 08, 2024]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (10)
High Cortisol Levels, What Female Symptoms Indicate This?
Video by EmpowHER/YouTube
Endocrinology - Adrenal Gland Hormones
Video by Armando Hasudungan/YouTube
Pharmacology - Glucocorticoids
Video by Armando Hasudungan/YouTube
How High Cortisol Impacts Physiology (and fat loss)
Video by FatIsNotYourFault/YouTube
The Complexities of Cortisol
Video by University of California Television (UCTV)/YouTube
How stress affects your brain - Madhumita Murgia
Video by TED-Ed/YouTube
Primary adrenal insufficiency (Addison's disease) - an Osmosis preview
Video by Osmosis/YouTube
Human Physiology - Cortisol Feedback and Function
Video by Janux/YouTube
Cortisol
The hippocampus is rich in receptors for cortisol. So cortisol is very active in the hippocampus. But sustained high levels of cortisol cause damage to neurons. Cortisol disrupts cellular metabolism of hippocampal neurons and increases the vulnerability of neurons to a variety of insults.5,6 In addition, when cortisol is elevated chronically, there is a reduction in neurogenesis.7 In a nutshell, the damage from cortisol in the hippocampus has been suggested to be an example of sacrificing long-term function (i.e., memory function) for the sake of short-term survival.8
Image by TheVisualMD
Cortisol
Cortisol is a hormone critical to many biological functions, including glucose metabolism, blood pressure, immunity, and thyroid regulation. The steroid hormone is produced by the adrenal glands and its release controlled by ACTH (adrenocorticotropic hormone), which is produced by the pituitary. Excess cortisol in the system is marked by a group of signs and symptoms known collectively as Cushing syndrome. Cortisol deficiency may be caused by dysfunction of the pituitary, known as secondary adrenal insufficiency; or by dysfunction of the adrenal glands, known as primary adrenal insufficiency or Addison's disease.
Image by TheVisualMD
0:56
High Cortisol Levels, What Female Symptoms Indicate This?
EmpowHER/YouTube
10:43
Endocrinology - Adrenal Gland Hormones
Armando Hasudungan/YouTube
9:10
Pharmacology - Glucocorticoids
Armando Hasudungan/YouTube
6:07
How High Cortisol Impacts Physiology (and fat loss)
FatIsNotYourFault/YouTube
2:41
The Complexities of Cortisol
University of California Television (UCTV)/YouTube
4:16
How stress affects your brain - Madhumita Murgia
TED-Ed/YouTube
0:52
Primary adrenal insufficiency (Addison's disease) - an Osmosis preview
Osmosis/YouTube
12:26
Human Physiology - Cortisol Feedback and Function
Janux/YouTube
Cortisol
TheVisualMD
Cortisol
TheVisualMD
ACTH Blood Test
ACTH Blood Test
Also called: Adrenocorticotropic Hormone, ACTH, Adrenocorticotrophin, Corticotropin
This test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is made by the pituitary gland and controls the production of a hormone called cortisol. Too much or too little cortisol can cause serious health problems.
ACTH Blood Test
Also called: Adrenocorticotropic Hormone, ACTH, Adrenocorticotrophin, Corticotropin
This test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is made by the pituitary gland and controls the production of a hormone called cortisol. Too much or too little cortisol can cause serious health problems.
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Use the slider below to see how your results affect your
health.
pg/mL
7.2
63.3
Your result is Normal.
Cortisol levels should peak in the morning and be at their lowest in the evening. ACTH reference interval for samples collected between 7 and 10 AM.
Related conditions
This test measures the level of adrenocorticotropic hormone (ACTH) in a sample of your blood. A hormone is a chemical messenger in your bloodstream that controls the actions of certain cells or organs. ACTH tells your adrenal glands, two small glands that sit above your kidneys, to make another hormone called cortisol.
Cortisol affects almost every organ and tissue in your body. It helps your body:
Respond to stress (cortisol is sometimes called the "stress hormone")
Reduce inflammation
Regulate blood glucose, also called blood sugar, and metabolism (how your body uses food for energy)
Control blood pressure
Because ACTH controls how much cortisol you make, ACTH testing is usually done with a blood test to measure your cortisol levels. Normally, if cortisol levels drop too low, your ACTH levels will increase to trigger your adrenal glands to make more cortisol. And if cortisol levels are high, ACTH levels will decrease so your adrenal glands will make less cortisol.
Your ACTH and cortisol levels are controlled by a complex feedback system of hormones made in different parts of your body. These include your:
Pituitary gland. This small gland is in the base of your brain. It makes ACTH and other hormones.
Hypothalamus. This is a part of your brain. It makes a hormone that tells your pituitary gland how much ACTH to make.
Adrenal glands. These glands respond to ACTH by making cortisol and releasing it into your bloodstream. The increased amount of cortisol in your blood signals your hypothalamus to stop making the hormone that tells your pituitary to make ACTH.
Conditions that affect any part of this system can affect the amount of cortisol in your body. Too much or too little cortisol can lead to serious health problems.
Other names: Adrenocorticotropic hormone blood test, corticotropin
An ACTH test is used to help diagnose and monitor conditions that affect cortisol levels. These conditions include disorders of the pituitary and adrenal glands.
High cortisol levels may be from:
Cushing's disease, a tumor in the pituitary gland that's usually benign (not cancer). The tumor makes too much ACTH, which triggers the adrenal glands to make too much cortisol. The tumor keeps making ACTH even when cortisol levels are high.
Cushing's syndrome, a disorder in which your body is exposed to too much cortisol over a long period of time. The extra cortisol may be caused by:
Long-term use of high doses of steroid medicine. Steroids can have side effects that increase cortisol levels.
Tumors in the adrenal glands that make extra cortisol, even when blood cortisol levels are high.
Tumors outside of the pituitary gland that make extra ACTH. This triggers the adrenal glands to make too much cortisol. These tumors are often found in the lungs, but they aren't common.
Low cortisol levels may be from:
Addison disease, a condition in which the adrenal glands can't make enough cortisol because they are damaged. The damage is usually caused by autoimmune disease.
Hypopituitarism, a condition in which the pituitary gland either stops making one or more hormones or can't make enough hormones, including ACTH. This rare disorder may be caused by pituitary tumors, damage to the pituitary gland, or a problem with the hypothalamus. If the pituitary gland can't make enough ACTH, the adrenal glands won't make enough cortisol.
ACTH and cortisol tests are used together to help find out which type of condition may be causing abnormal cortisol levels. Other tests are often needed to help make a final diagnosis.
You may need this test if you had abnormal results on a cortisol test or have symptoms of too much or too little cortisol.
Symptoms of too much cortisol may vary. They may include:
Weight gain
Thin arms and legs
Round face
Increased fat around the base of the neck or between the shoulder blades
Easy bruising
Wide purple streaks on the stomach, breasts, hips, and under the arms
Muscle weakness
Symptoms of too little cortisol include:
Long-lasting fatigue
Muscle weakness
Loss of appetite
Weight loss
Abdominal (belly) pain
You may also need this test if you have symptoms of hypopituitarism. Symptoms will vary depending on which pituitary hormones are affected and how low the levels are. If ACTH is decreased, you may have symptoms from low cortisol levels. If a tumor is causing hypopituitarism, symptoms may also include headaches and vision problems.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Your health care provider will tell you how to prepare for your test. You may need to fast (not eat or drink) for several hours before your test. Blood samples for ACTH testing are often taken early in the morning when ACTH levels are at their highest for the day.
You may need to stop taking certain medicines before this test, so tell your provider about everything you take. But don't stop taking any medicines unless your provider tells you to.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
To understand what the results of your ACTH test mean, your provider will usually compare your ACTH level with your cortisol level. If your results are abnormal, you may need other tests to confirm the specific cause. Ask your provider to explain what your test results say about your health.
In general:
High ACTH and high cortisol levels are a sign of pituitary tumor that makes ACTH (Cushing's disease). The extra ACTH triggers your adrenal glands to make too much cortisol.
You'll likely need more tests, such as a CT or MRI scan, to confirm whether you have a pituitary tumor. The high level of ACTH could also be from other causes including:
A rare type of tumor in your lung, pancreas, or thyroid gland
A condition called multiple endocrine neoplasia
High ACTH and low cortisol levels are a sign of damage to your adrenal glands (Addison disease). If your adrenal glands can't make enough cortisol, your pituitary gland usually makes more ACTH to try to get your adrenal glands to work better.
Low ACTH and high cortisol levels are a sign of Cushing's syndrome. This means that high cortisol levels may be caused by long-term use of steroid medicines or an adrenal gland tumor that makes extra cortisol. The high cortisol levels signal your hypothalamus and pituitary gland to decrease ACTH levels.
Low or normal ACTH and low cortisol levels are a sign of hypopituitarism. This means that a pituitary tumor or damage to your pituitary gland may prevent it from making enough ACTH. Without enough ACTH, your adrenal glands aren't stimulated to make enough cortisol. Over time, they may shrink.
Several other tests may be used to help diagnose the specific cause of abnormal cortisol levels. These tests measure changes in your ACTH or cortisol levels after you are given medicines that either trigger or stop the production of the hormones involved with making cortisol.
For example, an ACTH stimulation test is commonly used to help find out if a problem with your adrenal glands is causing low cortisol levels. This blood test measures your cortisol levels before and after you get an injection (shot) of ACTH. The results show whether your adrenal glands are able to respond normally to ACTH by making cortisol.
If your adrenal glands make a normal amount of cortisol after the shot, it suggests that a problem with your hypothalamus or pituitary gland is causing low cortisol levels. If your adrenal glands make little or no cortisol after the shot, you most likely have a problem that affects the health of your adrenal glands.
Adrenocorticotropic Hormone (ACTH): MedlinePlus Medical Test [accessed on Jan 27, 2024]
ACTH blood test: MedlinePlus Medical Encyclopedia [accessed on Jan 27, 2024]
Adrenocorticotropic Hormone (ACTH) Test - Testing.com. Dec 14, 2022 [accessed on Jan 27, 2024]
ACTH (Blood) - Health Encyclopedia - University of Rochester Medical Center [accessed on Jan 27, 2024]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (12)
Adrenocorticotropic Hormone
Adrenocorticotropic hormone is a polypeptide tropic hormone produced and secreted by the anterior pituitary gland. It is an important component of the hypothalamic-pituitary-adrenal axis and is often produced in response to biological stress (along with its precursor corticotropin-releasing hormone from the hypothalamus). Its principal effects are increased production and release of corticosteroids. A deficiency of ACTH is a cause of secondary adrenal insufficiency and an excess of it is a cause of Cushing's syndrome.
Image by TheVisualMD
Cortisol
The hippocampus is rich in receptors for cortisol. So cortisol is very active in the hippocampus. But sustained high levels of cortisol cause damage to neurons. Cortisol disrupts cellular metabolism of hippocampal neurons and increases the vulnerability of neurons to a variety of insults.5,6 In addition, when cortisol is elevated chronically, there is a reduction in neurogenesis.7 In a nutshell, the damage from cortisol in the hippocampus has been suggested to be an example of sacrificing long-term function (i.e., memory function) for the sake of short-term survival.8
Image by TheVisualMD
Anatomy and Physiology: Endocrine System: ACTH (Adrenocorticotropin Hormone) V2.0
ADH and aldosterone increase blood pressure and volume. Angiotensin II stimulates release of these hormones. Angiotensin II, in turn, is formed when renin cleaves angiotensinogen. (credit: modification of work by Mikael Häggström)
Image by CNX Openstax (credit: modification of work by Mikael Häggström)
Regulation of Body Processes
Professional baseball player Jason Giambi publically admitted to, and apologized for, his use of anabolic steroids supplied by a trainer. (credit: Bryce Edwards)
Image by CNX Openstax (credit: Bryce Edwards)
Regulation of Body Processes
Hormonal regulation of the female reproductive system involves hormones from the hypothalamus, pituitary, and ovaries.
Image by CNX Openstax
Regulation of Body Processes
The main symptoms of diabetes are shown. (credit: modification of work by Mikael Häggström)
Image by CNX Openstax (credit: modification of work by Mikael Häggström)
Cortisol
Cortisol is a hormone critical to many biological functions, including glucose metabolism, blood pressure, immunity, and thyroid regulation. The steroid hormone is produced by the adrenal glands and its release controlled by ACTH (adrenocorticotropic hormone), which is produced by the pituitary. Excess cortisol in the system is marked by a group of signs and symptoms known collectively as Cushing syndrome. Cortisol deficiency may be caused by dysfunction of the pituitary, known as secondary adrenal insufficiency; or by dysfunction of the adrenal glands, known as primary adrenal insufficiency or Addison's disease.
Image by TheVisualMD
Pituitary Gland
In normal functioning, environmental stress activates the hypothalamus to release corticotrophin releasing factor (CRF) which in turn stimulates the pituitary gland to increase production of adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal gland to release cortisol. It is cortisol that produces effects to help us deal with stress.
Image by TheVisualMD
Response to stress
In response to stress, the hypothalamus (H) releases the corticotrophin releasing factor (CRF) into the anterior pituitary (P), causing the release of adrenocorticotropic hormone (ACTH) into the blood flow. ACTH stimulates the generation of glucocorticoids (cortisol in humans and corticosterone in mice) in the cortex of the adrenal gland (A), which are then released into the blood. Stress also activates the autonomic sympathetic nerves in the medulla of the adrenal gland to elicit the production of catecholamines, norepinephrine and epinephrine, which are then released into the blood. Glucocorticoids and catecholamines influence the generation of interleukins, which are involved in the viability and proliferation of immunocompetent gut cells via receptors.
Image by Campos-Rodriguez R, Godinez-Victoria M, Abarca-Rojano E, Pacheco-Yepez J, Reyna-Garfias H, Barbosa-Cabrera RE, Drago-Serrano ME
Adrenocorticotropic Hormone
TheVisualMD
Cortisol
TheVisualMD
2:22
Anatomy and Physiology: Endocrine System: ACTH (Adrenocorticotropin Hormone) V2.0
DrBruce Forciea/YouTube
0:34
Adrenal Glands Animation
biosingh36/YouTube
HPA Axis
BrianMSweis
Regulation of Body Processes
CNX Openstax (credit: modification of work by Mikael Häggström)
Regulation of Body Processes
CNX Openstax (credit: Bryce Edwards)
Regulation of Body Processes
CNX Openstax
Regulation of Body Processes
CNX Openstax (credit: modification of work by Mikael Häggström)
Cortisol
TheVisualMD
Pituitary Gland
TheVisualMD
Response to stress
Campos-Rodriguez R, Godinez-Victoria M, Abarca-Rojano E, Pacheco-Yepez J, Reyna-Garfias H, Barbosa-Cabrera RE, Drago-Serrano ME
Deoxycorticosterone Test
Deoxycorticosterone Test
Also called: DOC
Deoxycorticosterone (DOC) is a non-active hormone that is necessary for the production of other hormones called cortisol and aldosterone. Increased DOC levels are related to disorders or tumors of the adrenal glands.
Deoxycorticosterone Test
Also called: DOC
Deoxycorticosterone (DOC) is a non-active hormone that is necessary for the production of other hormones called cortisol and aldosterone. Increased DOC levels are related to disorders or tumors of the adrenal glands.
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Use the slider below to see how your results affect your
health.
ng/dL
10
Your result is Low.
Related conditions
Deoxycorticosterone (DOC) is a steroid hormone that serves as a precursor for other hormones known as cortisol and aldosterone, which are produced by the adrenal glands (small organs located at the top of each kidney).
This test measures the amount of deoxycorticosterone in a sample of your blood.
Your doctor may want to order this test when you have signs and symptoms that could be related to abnormal cortisol or aldosterone levels, such as:
Resistant hypertension (high blood pressure that does not respond adequately to treatment)
Polyuria (frequent urination)
Polydipsia (excessive thirst)
Edema (swelling)
Enlarged heart
This test can also be used to confirm hyperfunction (excessive activity) of the adrenal glands, tumors of the adrenal glands, and to monitor treatment for these conditions.
A needle will be used to extract a small amount of blood from a vein in your arm.
No fasting or other preparations are needed. However, you should inform your healthcare practitioner if you are taking any over-the-counter or prescription drugs.
You may feel discomfort when the needle is inserted and extracted, but, otherwise, it is a quick procedure. You may also experience bruising and a little bleeding, as well as mild soreness for a short amount of time after the blood extraction.
Normal deoxycorticosterone levels are:
In children and adolescents who are younger than 18 years of age: less than 30 ng/dL
In adults: less than 10 ng/dL
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (6)
Adrenal Gland
Visualization of the adrenal gland. The adrenal gland is made up of two separate glands, the adrenal cortex and the adrenal medulla, which serve two different endocrine functions. The outer portion, the adrenal cortex is responsible for the synthesis of 3 different hormones: aldosterone is responsible for maintaining healthy sodium levels and helps to maintain blood volume and blood pressure; cortisol controls how the body uses fat, protein, carbohydrates and minerals; gonado-coricoids are sex hormones which influence sperm production in men and menstruation in women. The inner portion of the adrenal gland is called the adrenal medulla and it is responsible for the synthesis of epinephrine and norepinephrine. Epinephrine stimulates carbohydrate metabolism and norepinephrine raises heart rate and blood pressure.
Image by TheVisualMD
Adrenal Gland Showing Cortex and Medulla
Medical visualization of a cross-section of the adrenal gland. The adrenal gland is actually made up of two separate glands, the adrenal cortex and the adrenal medulla, which serve two different endocrine functions, and have separate innervation and developmental origins. The outer portion, the adrenal cortex, is responsible for the synthesis of three different types of hormones: mineralcorticoids (primarily aldosterone) maintain healthy sodium levels and help to maintain blood volume and blood pressure; glucocorticoids (primarily cortisol) control the body's use of glucose, fat, protein, carbohydrates, and minerals; and gonadocorticoids (mainly androgens such as testosterone) influence puberty, secondary sex characteristics, and sex drive. The inner portion of the adrenal gland, the adrenal medulla, is responsible for the synthesis of epinephrine and norepinephrine. Epinephrine stimulates carbohydrate metabolism and norepinephrine raises heart rate and blood pressure.
Image by TheVisualMD
Adrenal Gland
ACTH stimulates the adrenal gland to release cortisol. It is cortisol that produces effects to help us deal with stress.
Image by TheVisualMD
Adrenal gland
Adrenal gland
Image by EEOC
human adrenal gland (Zona fasciculata)
human adrenal gland (Zona fasciculata)
Image by Jpogi (talk)
Deoxycorticosterone
Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. Progesterone belongs to a class of hormones called progestogens, and is the major naturally occurring human progestogen.
Image by TheVisualMD
Adrenal Gland
TheVisualMD
Adrenal Gland Showing Cortex and Medulla
TheVisualMD
Adrenal Gland
TheVisualMD
Adrenal gland
EEOC
human adrenal gland (Zona fasciculata)
Jpogi (talk)
Deoxycorticosterone
TheVisualMD
Treatment
Cortisol Molecules
Image by TheVisualMD
Cortisol Molecules
The hippocampus is rich in receptors for cortisol. So cortisol is very active in the hippocampus. But sustained high levels of cortisol cause damage to neurons. Cortisol disrupts cellular metabolism of hippocampal neurons and increases the vulnerability of neurons to a variety of insults.5,6 In addition, when cortisol is elevated chronically, there is a reduction in neurogenesis.7 In a nutshell, the damage from cortisol in the hippocampus has been suggested to be an example of sacrificing long-term function (i.e., memory function) for the sake of short-term survival.
Image by TheVisualMD
What Are the Treatments for Cushing Syndrome?
Treatment for Cushing syndrome depends on the cause of the extra cortisol in the body.
Medicine
For cases of Cushing syndrome caused by taking medicine to treat another disorder, your healthcare provider will, if possible, decrease the dose slowly and carefully and then give another medication so the body can go back to making its own cortisol.
In cases where it is not possible to stop the medication, the healthcare provider will monitor the patient closely and treat symptoms that might develop, such as high blood sugar, high cholesterol levels, bone thinning, or osteoporosis.
Tumors
If a tumor is the cause of Cushing, treatments may include medication, surgery, radiation, chemotherapy, or a combination of these treatments. The treatment depends on the tumor’s location and type.
Pituitary tumors
The most common treatments for pituitary tumors are:
Surgery. In most cases, a surgeon removes the tumor through a cut under the upper lip or at the bottom of the nose, between the nostrils. In rare cases, the surgeon may cut through the skull to reach the pituitary tumor.
Radiation therapy. Radiation therapy uses X-rays to kill tumor cells or keep them from growing. It can be used if some tumor cells remain after surgery.
Chemotherapy. Chemotherapy uses drugs that kill tumor cells or keep them from growing. Some chemotherapy drugs are taken by mouth, and some are injected.
Drug therapy. Drugs can correct hormone imbalances or replace cortisol after another treatment.
To find out more about pituitary tumor treatments, visit the National Cancer Institute’s page on pituitary tumors.
Adrenal tumor or other tumors
If the tumor is in one or both of your adrenal glands, you may need surgery to remove it. Often, providers will remove the whole adrenal gland. After surgery to remove one adrenal gland, you may need to take drugs for several months to keep your cortisol levels up until the other adrenal gland is making enough by itself. After surgery to remove both adrenal glands, you will need to take medications to replace adrenal function for the rest of your life and take additional precautions during illness or surgery.
If your healthcare provider cannot remove the tumor, medications can help block the release of cortisol. Radiation therapy usually is not used for adrenal tumors.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Additional Materials (3)
Cushing's disease treatment at OHSU Pituitary Center
Video by OHSU/YouTube
Cushing's Disease Treatment
Video by UC San Diego Health/YouTube
Cushing's Syndrome and Corticosteroids (Part 2)
Video by Medicurio/YouTube
1:56
Cushing's disease treatment at OHSU Pituitary Center
OHSU/YouTube
3:17
Cushing's Disease Treatment
UC San Diego Health/YouTube
8:15
Cushing's Syndrome and Corticosteroids (Part 2)
Medicurio/YouTube
Complications
Heart Disease-Heart attack
Image by TheVisualMD
Heart Disease-Heart attack
Heart Disease-Heart attack
Image by TheVisualMD
What Are the Complications of Cushing’s Syndrome?
Cushing’s syndrome can cause health problems such as
heart attack and stroke
blood clots in the legs and lungs
infections
bone loss and fractures
high blood pressure
unhealthy cholesterol levels
depression or other mood changes
memory loss or trouble concentrating
insulin resistance and prediabetes
type 2 diabetes
Although Cushing’s syndrome can usually be cured, it can be fatal if not treated.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (3)
Cushing Disease & ACTH-Secreting Pituitary Tumors – Mayo Clinic
Video by Mayo Clinic/YouTube
What is Cushing's Disease?
Video by Swedish/YouTube
Cushing's Syndrome
Video by NBC4 Columbus/YouTube
3:41
Cushing Disease & ACTH-Secreting Pituitary Tumors – Mayo Clinic
Mayo Clinic/YouTube
3:10
What is Cushing's Disease?
Swedish/YouTube
2:05
Cushing's Syndrome
NBC4 Columbus/YouTube
Prognosis
Hirsutism and strias were shown in the patient with iatrogenic Cushing's syndrome
Image by Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu
Hirsutism and strias were shown in the patient with iatrogenic Cushing's syndrome
Hirsutism and strias were shown in the patient with iatrogenic Cushing's syndrome
Image by Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu
Is There a Cure for Cushing Syndrome?
Untreated Cushing syndrome can be life-threatening. Fortunately, most people with the syndrome are treated and cured.
However, after successful treatment of the syndrome, some health problems may continue. For instance, your bones may continue to be weak. People who no longer have Cushing syndrome may be more likely to have high blood pressure, diabetes, and mental health issues, such as depression and anxiety.
People whose Cushing syndrome was caused by a tumor need to have regular checkups for the rest of their lives to check for additional tumors. For many adults with Cushing disease (the term used for Cushing syndrome caused by a pituitary adenoma), surgical removal of the tumor is successful. In rare cases, some of the tumor cells are left and the adenoma can grow back.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Cushing's Syndrome
Cushing syndrome is caused by chronic exposure of the body’s tissues to high levels of cortisol—a hormone produced by the adrenal glands. This can be from long-term use of certain medications or tumors of the pituitary or adrenal glands. Your treatment will depend on why you have too much cortisol. Learn more about this rare disorder.